Research and Articles
At Osteopathy Australia, our aim is to build a strong evidence base for the work of osteopaths. This involves reviewing the available literature to highlight relevant research for members, particularly with regard to its significance in clinical practice. The articles below are regularly updated with new information.
To assist researchers, we have put together resource sheets that provide information on common research topics such as grant writing, preparing manuscripts, and data analysis. There will be more sheets added over time. A full list of resource sheets can be found at the bottom of this page.
Diagnostic labelling and management intentions for low back pain
When scoping the literature, diagnostic labelling has its advantages and disadvantages and may have an influence on how clinicians go about treatment. A study in the European journal of pain has looked at the effect of labelling on low back pain management – focusing on primarily on beliefs such as imaging, second opinions, surgery, and seriousness. With over 1300 participants included in the study, the authors noted that specific labels such as “Episode of back pain”, “lumbar sprain” and “non-specific LBP” reduced the need for imaging, surgery and second opinion when compared to labels such as “arthritis”, “degeneration” and “disc bulge”. The results suggested that diagnostic labelling may be most relevant among individuals who are more at risk of poor outcomes such as participants suffering from low back pain who also have a history of seeking care.
O'Keeffe, M., Ferreira, G. E., Harris, I. A., Darlow, B., Buchbinder, R., Traeger, A. C., Zadro, J. R., Herbert, R. D., Thomas, R., Belton, J., & Maher, C. G. (2022). Effect of diagnostic labelling on management intentions for non-specific low back pain: a randomised scenario-based experiment. European journal of pain (London, England), 10.1002/ejp.1981. Advance online publication.
High-load compared vs low-load strengthening exercise on hypermobile shoulders
An RCT published in the British Journal of Sports Medicine has looked at the short-term effectiveness of high vs low-load strengthening exercise on hypermobile shoulders. 93 participants completed the trial which consisted of two groups who completed either a high or low load exercise program over four months. The authors noted significant between-group differences which favoured the high load exercise group with the high load group also showing improved symptoms (though not significant). The authors also noted more muscle soreness in the high load exercise group. The findings suggest that high load exercise may be used in primary care to treat patients with hypermobile shoulders although more research is needed to confirm this finding and assess its efficacy over a longer time frame.
Liaghat, B., Skou, S. T., Søndergaard, J., Boyle, E., Søgaard, K., & Juul-Kristensen, B. (2022). Short-term effectiveness of high-load compared with low-load strengthening exercise on self-reported function in patients with hypermobile shoulders: a randomised controlled trial. British journal of sports medicine, bjsports-2021-105223.
A guide to the management of geriatric osteoporosis
Osteoporosis is a common musculoskeletal disease, more so in elderly individuals, and is often characterised by a loss of bone density and fragility. Allied health professionals play an important role in supporting and managing patients who suffer from this musculoskeletal condition. An article in the International Journal of Osteopathic Medicine has provided a clinician’s guide (for allied health professionals) to managing osteoporosis in elderly patients. The detailed article covers an array of key factors such as pathophysiology, screening, risk factors, management guidelines, and referral information.
Feehan, J., Tripodi, N., Fleischmann, M., Zanker, J., & Duque, G. (2022). A clinician's guide to the management of geriatric musculoskeletal disease: Part 1 - Osteoporosis. International Journal of Osteopathic Medicine, (43) 53-62.
A guide to the management of geriatric sarcopenia
Sarcopenia is more recently identified condition associated with the loss of muscle mass and strength. The condition is also commonly seen in aging populations. As a continuation of the masterclass article on geriatric musculoskeletal conditions published in the International Journal of Osteopathic Medicine (above) – this article provides a clinician’s guide (for allied health professionals) to managing sarcopenia in elderly patients. The detailed article similarly covers various topics such as pathophysiology, risk factors, and management options.
Tripodi, N., Wright, B., Lawton, A., Zanker, J., Feehan, J. (2022). A clinician's guide to the management of geriatric musculoskeletal disease: Part 2 – Sarcopenia. International Journal of Osteopathic Medicine, In Press.
Greater work physical activity linked to higher risk of knee osteoarthritis
A study published in the journal of Occupational and Environmental Medicine has suggested that individuals who have more physically active occupations may at an increased risk of suffering from knee osteoarthritis. The longitudinal study included 951 patients with over 2800 observations and noted that those with more physical roles, especially those who worked while standing or that involved some walking were more at risk when compared to those with mainly sedentary roles.
Lo, G. H., Richard, M. J., McAlindon, T. E., Park, C., Strayhorn, M. T., Harkey, M. S., Price, L. L., Eaton, C. B., & Driban, J. B. (2022). Increased risk of incident knee osteoarthritis in those with greater work-related physical activity. Occupational and environmental medicine, oemed-2022-108212.
Osteopathy in conjunction with physiotherapy for fatigue in long COVID: Study protocol
Long COVID is often characterised by ongoing symptoms such as respiratory and cardiovascular issues and more commonly, fatigue. A study protocol recently published in the International Journal of Osteopathic Medicine thus aims to compare the effectiveness of osteopathic manipulative treatment combined with physio when compared to physio alone on fatigue and functional limitations in adults with long COVID. The study is to be conducted in a public health primary-to-tertiary setting using an assessor-blinded, pragmatic randomized controlled superiority trial.
Certain Curi, A. C., Antunes Ferreira, A. P., Calazans Nogueira, L. A., Mello Meziat Filho, N. A., & de Sá Ferreira, A. (2022). Osteopathy and physiotherapy compared to physiotherapy alone on fatigue in long COVID: Study protocol for a pragmatic randomized controlled superiority trial. International journal of osteopathic medicine: IJOM, 10.1016/j.ijosm.2022.04.004. Advance online publication.
Low back pain and related disability in non-care-seeking adults
A study in the journal Musculoskeletal Science and Practice has explored the occurrence and extent of low back pain and its related disability in adults who are not seeking care. 101 adults were included in study and completed a range of questionnaires on back pain and disability. Over 70% of participants showed some level of disability and nearly half reported some level of pain. As the individuals assessed were not seeking care in any form, the authors suggested that some level of disability and pain associated with lower back pain may be manageable or perhaps just considered normal.
Vraa, M., Pascoe, S., Maddox, D., Rhon, D. I., Cleland, J. A., & Young, J. L. (2022). Prevalence and extent of low back pain and low back-related disability in non-care-seeking working-age adults. Musculoskeletal Science and Practice, 102572.
Pain experience and the Emergency Department
With an overall reduction in opioid prescribing in line with various practice recommendations, some individuals who seek acute pain relief may be left with unrelieved pain. Punches and team have explored ED patients’ beliefs and experiences on pain and emergency care. The study used semi structed interviews and subsequent framework analysis to gather information and determine key themes. Interestingly, patients that were interviewed reported unrelieved pain on ED discharge and an interest in seeking opioids from non-medical sources - strongly emphasising the disconnect between patients and emergency care providers. The study hopes to increase the information available for the development of future psychosocial interventions which must focus on balancing acute pain management needs with opioid exposure risks.
Punches, B. E., Brown, J. L., Soliman, S., Johnson, K. D., Freiermuth, C. E., Walker, Q., ... & Lyons, M. S. (2022). Patient Pain Experiences and the Emergency Department Encounter: A Qualitative Analysis. Pain Management Nursing.
Study mapping of the 2021 NICE guidelines for assessment and management of chronic pain against a community sample
A recent study published in the British Journal of Pain has looked at common pain management strategies among adults in the UK and has compared them to the recent NICE guidelines (NG-193) for the management of chronic pain. Using an online survey, the researchers collected information on pain severity, interference, sleep, and mental health. The authors noted that respondents often used strategies such as exercise, physical therapy, psychological therapy, and pharmacological therapy – mostly in line with the NICE guidelines with the exception of pharmacological use where a number of participants still reported the use of opioids.
Zambelli, Z., Halstead, E. J., Iles, R., Fidalgo, A. R., & Dimitriou, D. (2022). The 2021 NICE guidelines for assessment and management of chronic pain: A cross-sectional study mapping against a sample of 1,000* in the community. British Journal of Pain, 20494637221083837.
Systematic Review Protocol: pain sensitisation for low back pain
Low back pain remains one of the most common disabilities worldwide and while many non-operative treatments remain available for the condition, there is little conclusive evidence on their respective effectiveness. A recent systematic review registered with PROSPERO looks to evaluate the safety and effectiveness of nonoperative treatment for pain sensitization for low back pain by reviewing original RCTs of nonoperative interventions. See the link below for more information about the review protocol.
Nopsopon, T., Suputtitada, A., Lertparinyaphorn, I., & Pongpirul, K. (2022). Nonoperative treatment for pain sensitization in patients with low back pain: protocol for a systematic review. Systematic Reviews, 11(1), 1-7.
Neck extensor muscle exercises for women with chronic idiopathic neck pain
Individuals with neck pain may show structural and functional impairments of the cervical extensor muscles and while global nonspecific neck exercises have shown improvements in neck pain and functionality, specific exercises have not been as readily assessed. Giménez-Costa and team from the University of Alcalá, Spain have conducted an RCT with 43 women comparing the effect of lower deep neck extensor exercises to general neck extensor exercises on neck pain and disability. Both groups showed improvements and reductions in disability at short term and long term follow up – suggesting that the two exercises had comparable outcomes, but the study could not determine if one exercise treatment option was more beneficial than the other.
Costa, M. G., Schomacher, J., Murillo, C., Sentandreu, T., Falla, D., & Lluch, E. (2022). Specific versus non-specific exercises for the neck extensor muscles in women with chronic idiopathic neck pain: A randomized controlled trial. Musculoskeletal Science and Practice, 102561.
An epidemiological study on early onset scoliosis
While the understanding of early onset scoliosis (classified as any curved deformity of the spine for children under 10) is growing, the knowledge of its prevalence and incidence is lacking. A study published in The Spine Journal by AlNouri and team has undertaken a multicentre retrospective cohort study to address this lack of information. They noted an annual incidence of .019% and prevalence of .077% with neuromuscular related scoliosis being the most common, followed by idiopathic, syndromic, and congenital. The findings support the current evidence suggesting that early onset scoliosis is rare and further notes the importance of early diagnosis and intervention.
Al Nouri, M., Wada, K., Kumagai, G., Asari, T., Nitobe, Y., Morishima, T., ... & Ishibashi, Y. (2022). The Incidence and Prevalence of Early-Onset Scoliosis: A Regional Multicenter Epidemiological Study. The Spine Journal.
Headache knowledge among UK osteopaths
The popularity of complementary and alternative medicine for headache sufferers continues to increase as people seek alternatives to the usual pharmaceutical route. With increase in mind, a survey of 383 osteopaths published in the International Journal of Osteopathic Medicine has assessed the existing knowledge of headache disorders among registered osteopaths practising in the UK. While mean knowledge scores were good, existing knowledge relied on prior headache education. Further themes identified that osteopaths acknowledged gaps in their knowledge and desired more headache education which if achieved, may improve patient care.
Huzzey-Cunningham, E., McWilliam, M., Mahtani, V., Bridge, H., Breukel, C., Schytz, H. W., & Draper-Rodi, J. (2022). Study to assess existing knowledge of headache disorders among registered osteopaths practising in the UK: A cross-sectional survey. International Journal of Osteopathic Medicine.
Musculoskeletal adaptations to training and sport performance
Both coaches and researchers can benefit from improving their knowledge and understanding of training and body adaptations. As such, an editorial in the Frontiers inn Physiology (Exercise Psyhsiology) has covered musculoskeletal adaptations to training focusing primarily on the connection between training practices and sports performance. The editorial covers areas ranging from the general trainability to specific athlete responses to new tools with physiological, biochemical, and even molecular insights.
Marinho D., Ferraz R., Toubekis A., Neiva H. (2022). Editorial: Musculoskeletal Adaptations to Training and Sports Performance: Connecting Theory and Practice. Frontiers in Physiology. 13 10.3389/fphys.2022.866895
Musculoskeletal and sports ultrasound terminology
Various streams and specialities of musculoskeletal and sports medicine have seen a steep rise in use of ultrasounds for guidance and diagnostic imaging. However, the lack of consensus around standardised terminology can easily lead to confusion between clinicians and even researchers when conveying information. A consensus statement published in the British Journal of Sports Medicine has utilised a Delphi based consensus statement on the issue, providing a point of reference to improve clarity and consistency for communicating. The expert panel consisted of 18 members from multiple specialty societies in musculoskeletal and sports ultrasound.
Hall, M. M., Allen, G. M., Allison, S., Craig, J., DeAngelis, J. P., Delzell, P. B., ... & Tagliafico, A. (2022). Recommended musculoskeletal and sports ultrasound terminology: a Delphi-based consensus statement. British Journal of Sports Medicine, 56(6), 310-319.
Osteopathic treatment in addition to standard care for GERD
A study by Lynen and Team in the Journal of Bodywork and Movement Therapies has conducted a RCT on the effectiveness of osteopathy (in addition to standard care) for patients with Gastroesophageal Reflux Disease (GERD) (known more commonly as acid reflux). 70 patients were randomly assigned into an osteopathic treatment group and a controlled untreated group with a mix of outcomes measures used to gather data on medication use, gastrointestinal symptoms, reflux, and quality of life. While medication use decreased and quality of life improved for the treatment group, reflux symptoms appeared to decrease however, there is uncertainty around this decrease due to participants completing the questionnaire incorrectly.
Lynen, A., Schömitz, M., Vahle, M., Jäkel, A., Rütz, M., & Schwerla, F. (2022). Osteopathic treatment in addition to standard care in patients with Gastroesophageal Reflux Disease (GERD)–A pragmatic randomized controlled trial. Journal of Bodywork and Movement Therapies, 29, 223-231.
The No Worries Trial – an emotional recovery program for people living with chronic pain
Chronic pain affects around 1 in 5 Australians, impacting their daily lives and often causing various forms of distress. Researchers from NeuRA and UNSW have developed an online emotional recovery program aimed at people who live with chronic pain. Published in the Journal of Pain, the program was shown to reduce pain intensity by teaching users how to regulate difficult and intense emotions. The program is delivered online which also allows for greater accessibility.
Norman-Nott, N., Wilks, C. R., Hesam-Shariati, N., Schroeder, J., Suh, J., Czerwinski, M., & Gustin, S. M. (2021). The No Worries Trial: Efficacy of Online Dialectical Behaviour Therapy Skills Training for Chronic Pain (iDBT-Pain) Using a Single Case Experimental Design. The Journal of Pain.
A continued look at pain during COVID-19
COVID-19 continues to affect healthcare delivery in almost every aspect. With ongoing delays to healthcare access, interest has been building regarding the effect of COVID-19 on pain management. Chatkoff and team have explored the pandemics impact on chronic the pain experience, surveying over 400 patients with musculoskeletal, neuropathic, or postsurgical pain. The results noted that patients’ perceptions and experiences of chronic pain were negatively affected by the pandemic and that there was a pandemic related worsening of the chronic pain experience. The clinical implications are clear, suggesting that patients who suffer from chronic pain may need additional support and guidance while the pandemic is still ongoing.
Chatkoff, D. K., Leonard, M. T., Najdi, R. R., Cruga, B., Forsythe, A., Bourgeau, C., & Easton, H. (2022). A Brief Survey of the COVID-19 Pandemic's Impact on the Chronic Pain Experience. Pain Management Nursing, 23(1), 3-8.
Differentiating early-stage spondylolysis from nonspecific low back pain in adolescents
Acute low back pain in adolescents can often be caused by early-stage spondylolysis (ESS). While accurate diagnosis of ESS is of key importance for providing appropriate treatment options, differentiating ESS from other forms of lower back pain/lower back disorders is difficult when looking for physical signs alone – yet a physical marker is often needed for further MRI imaging. As such, a study published in the journal Musculoskeletal Science and Practice has aimed to determine common characteristics for motion-provoking lower back pain in patients with ESS. After assessing 112 adolescents, the results suggested that lateral bending was the greatest motion-provoking characteristic of lower back pain for patients with ESS.
Sugiura, S., Aoki, Y., Toyooka, T., Shiga, T., Otsuki, K., Aikawa, E., Oyama, T., Kitoh, K., Chikako, S., Takata, Y., Ishizaki, T., Omori, Y., Kiguchi, Y., Takata, A., Kote, A., Nakanishi, Y., Matsushita, Y., Suzuki, T., Mori, C., Takahashi, K., … Nishikawa, S. (2015). Characteristics of low back pain in adolescent patients with early-stage spondylolysis evaluated using a detailed visual analogue scale. Spine, 40(1), E29–E34.
PERSiST (implementing Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science
Systematic review reporting has become ever more transparent due to the use of standardised reporting guides which allow readers of a systematic review to understand what was done, why it was done, and how it was done. But while standardised reporting exists, it is not universally used and as such, poor reporting of systematic reviews remains an issue. A consensus statement published in the British Journal of Sports Medicine has provided implementation guidance for using PRISMA in systematics reviews for sport and exercise medicine, musculoskeletal rehabilitation, and sports science. Ardern and team utilised a mix of content and methodology experts to identify strong examples of systematic review reporting in the aforementioned fields resulting in PERSiST – a guide for implementing PRISMA to improve transparency and reporting of systematic reviews in exercise, rehabilitation, sport medicine and sports science.
Ardern, C. L., Büttner, F., Andrade, R., Weir, A., Ashe, M. C., Holden, S., ... & Winters, M. (2022). Implementing the 27 PRISMA 2020 Statement items for systematic reviews in the sport and exercise medicine, musculoskeletal rehabilitation and sports science fields: the PERSiST (implementing Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science) guidance. British journal of sports medicine, 56(4), 175-195.
A look at novice athletes and injury rates
Physical activity is a clear cornerstone in everyday health and wellbeing. With many individuals living a more sedentary lifestyle, public health initiatives often focus on getting active. While these initiatives are magnificent, injuries incurred by those new to fitness may have long term negative effects. A study by Kemler and team in BMJ Open Sport and Exercise Medicine has explored whether there has been an increase in novice athletes and their injury rates. As may be expected, the team noted that injury risk was higher in novice athletes when compared to experienced athletes regardless of the fitness activity. The results enforce that attention must be paid to injury prevention in newer athletes to prevent drop-out rates and ensure safe exercise practices.
Kemler, E., Valkenberg, H., & Verhagen, E. (2022). More people more active, but there is a counter site. Novice athletes are at highest risk of injury in a large population-based retrospective cross-sectional study. BMJ Open Sport & Exercise Medicine, 8(1), e001255.
Pain management during COVID-19
An editorial in the Journal of Pain Management Nursing has explored how pain has been managed during the COVID-19 pandemic. The authors looked at various article’s from countries such as Spain, China, and the United States – with research ranging from pain among those with COVID, those who suffer from pain during COVID, and the effect of the pandemic on pain care.
Practitioner attitudes and lower back pain
Lower back pain remains a common problem, affecting over 2 billion people around globally. A study in Musculoskeletal Science and Practice has explored the lower back pain attitudes of physical therapists. The team surveyed 420 therapists and noted several factors associated with lower back pain attitudes such as post grad training, fellowship training, and practice type (e.g., private practice). The findings suggested that therapists who had certifications in orthopaedics or sports, greater pain knowledge, and who worked in hospital settings were tended to have more helpful attitudes towards lower back pain.
A feasibility RCT on the use of osteopathic treatment for neck-shoulder pain.
Computer use and computer-based tasks are commonplace worldwide for social, recreational, and work-related activities. It is also a common source of pain, more often from poor posture during use. A study in the journal of Complementary Therapies in Clinical Practice has outlined a feasibility RCT to assess the effect of osteopathic care on neck-shoulder pain in computer users. The trial consisted of 30 adults who were daily computer users. The feasibility RCT objectives were met, suggested that a larger scale RCT would be feasible in the future. Furthermore, the PPT results suggested that osteopathic treatment increased pain thresholds compared to sham treatments and usual care – increasing the evidence supporting the use of osteopathic treatments for musculoskeletal pain.
Santiago, R. J., Esteves, J. E., Baptista, J. S., Magalhães, A., & Costa, J. T. (2022). Results of a feasibility randomised controlled trial of osteopathy on neck-shoulder pain in computer users. Complementary Therapies in Clinical Practice, 46, 101507.
Respiratory Physiotherapy for COPD: a review
Chronic Obstructive Pulmonary Disease (COPD) remains one of the most prevalent respiratory diseases worldwide and research into the role of allied health professionals such as physiotherapists around COPD is increasing. A systematic review by Leemans and team has investigated the cost effectiveness of respiratory physiotherapy (e.g., exercise training) for individuals with COPD. While only 11 studies were included in the final analysis (of which only four were interpreted as cost effective), the team noted that physiotherapy interventions had the potential to be cost effective, though further research is needed in the area.
Leemans, G., Taeymans, J., Van Royen, P., & Vissers, D. (2021). Respiratory physiotherapy interventions focused on exercise training and enhancing physical activity levels in people with chronic obstructive pulmonary disease are likely to be cost-effective: a systematic review. Journal of Physiotherapy. 67(4), 271-283
Cardiometabolic health improvements after high intensity interval training
A recent study published in the Journal of Exercise Science and Fitness has suggested that both high intensity interval training and moderate intensity continuous training both alone and alternating was able to improve cardiometabolic health in obese middle-aged men. 48 participants aged between 40-59 took part in the study, all of whom were previously inactive. The study was able to utilise a randomized control research design with free living conditions to better reflect everyday lifestyle habits. In addition to improvements in cardiometabolic health, the authors also noted an overall reduction in weight, waist circumference, BMI, and percentage fat in each of the exercise groups.
Poon, E. T. C., Little, J. P., Sit, C. H. P., & Wong, S. H. S. (2020). The effect of low-volume high-intensity interval training on cardiometabolic health and psychological responses in overweight/obese middle-aged men. Journal of Sports Sciences, 38(17), 1997-2004.
A review of manual palpation for low back pain assessment
A review in the Journal of Chiropractic & Manual Therapies has investigated the reliability and validity of manual palpation for the assessment of lower back pain. The research team identified 14 articles to be included in their evidence synthesis out of over 2000 articles originally identified. However, they were unable to find consistency in the assessments commonly used by manual therapists suggesting that reliability of these assessments varies greatly. As there was little consistency in the articles and little evidence is available on the validity of these assessments, more research is needed in the area to build a strong evidence profile for the use of palpation in the assessment of lower back pain.
Nolet, P. S., Yu, H., Côté, P., Meyer, A. L., Kristman, V. L., Sutton, D., Murnaghan, K., & Lemeunier, N. (2021). Reliability and validity of manual palpation for the assessment of patients with low back pain: a systematic and critical review. Chiropractic & manual therapies, 29(1), 1-20.
Advice giving for patients with lower back pain
Advice giving for patients with low back pain is often endorsed in best practice statements and clinical guidelines – but little is known about the extent of health promotion and what actual advice is given to patients who see manual therapists or acupuncturists. As such, a novel study by Osborn-Jenkins and team from the University of Southampton has described advice giving practices in physiotherapists, osteopaths, and acupuncturists in the UK. The results noted a broad scope of advice with majority of practitioners offering exercise advice.
Osborn-Jenkins, L., Roberts, L., Al-Abbadey, M., MacPherson, H., Stuart, B., Carnes, D., Fawkes, C., Yardley, L., Bradbury, K., & Bishop, F. L. (2021). Advice-giving practice in physiotherapy, osteopathy, and acupuncture for people with low back pain. Physiotherapy, 113, e164-e165.
GUIDELINES: Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management
The UK National Institute for Health and Care Excellence (NICE) released updated guidelines on the diagnosis and management of myalgic encephalomyeltis/chronic fatigue syndrome
Respiratory Palpation in Osteopathic Manual Medicine
An article published in Cureas has noted the clear lack of literature in regarding palpation of the lower respiratory tree and the failure to demonstrate how to perform palpation of said area. The review article thus covers innervation of the respiratory tree, the mechano-metabolic weight of the passage of fluids and air in the respiratory tract, anatomical topography, and respiratory movements – illustrating hand placement for effective osteopathic assessment of respiratory structures such as the tracheal, bronchial, structures.
Large analysis shows the high burden of musculoskeletal disorders for 195 Countries and Territories
Musculoskeletal disorders have an ever-increasing prevalence globally and can severely affect an individual’s quality of life. A study in the Journal of Arthritis & Rheumatology has provided an overview of the burden of musculoskeletal disorders in a global context. The researchers examined data from the Global Burden of Disease Study 2017 which covered musculoskeletal disorders such as (but not limited to) rheumatoid arthritis, osteoarthritis, neck pain, lower back pain. The team found that there were approximately 1.3 billion prevalent cases of musculoskeletal disorders around the world in 2017 and that the burden of these diseases tended to increase with age, was more common among females, and was higher in developed countries.
OCTOBER 2021: Journal Focus – Musculoskeletal Science and Practice
Issues in identifying serious pathology in Musculoskeletal care during and after COVID
Identifying serious pathology in musculoskeletal care is challenging at the best of times and the COVID 19 pandemic seems to have compounded the issue as consultations have moved online, limiting assessment and decision-making capabilities. A paper published in the Journal Musculoskeletal Science and Practice discusses the complexities of identifying serious pathology as well as clinical risk and management strategies.
Paling, C. (2021). The complex problem of identifying serious pathology in Musculoskeletal care: Managing clinical risk during the COVID pandemic and beyond. Musculoskeletal Science and Practice, 102379
A look at manual therapy techniques for migraine
Migraines are much more than just a simple headache and over 4 million Australians experience migraines at some point in time. Not only are they a literal pain, but they often lead to a significant reduction productivity. A study published in the Journal Musculoskeletal Science and Practice has suggested that Articulatory manual therapy may reduce pain intensity, disability, and medication intake in patients who suffer from migraines. The study also reported on short term sustained improvements in quality of life. However, a variety of articulatory techniques were used and thus the observed improvements could not be attributed to a singular technique.
Muñoz-Gómez, E., Inglés, M., Serra-Añó, P., & Espí-López, G. V. (2021). Effectiveness of a manual therapy protocol based on articulatory techniques in migraine patients. A randomized controlled trial. Musculoskeletal Science and Practice, 54, 102386.
Care seeking in adolescents with neck and low back pain
Neck and lower back pain are often associated with adulthood and more often with old age, however, there is an increasing prevalence of these conditions in younger individuals, but questions remain as to their care seeking behaviours and what may influence younger patients to seek care for neck and back pain. A study by Oliveira and team from the Universidade Estadual Paulista (UNESP) in Brazil noted that around 1/3 of adolescents in their study with neck or low back pain sought healthcare. They also found that adolescents were more likely to seek care for if they reported daily activity limitations due to their pain, had higher physical activity at school, or were encouraged to practice physical activity by others.
Oliveira, C. B., Pinto, R. Z., Damato, T. M., Lemes, I. R., Delfino, L. D., Tebar, W. R., & Christofaro, D. G. (2021). Daily activity limitations and physical activity encouragement influence adolescents seeking health care for neck and low back pain. Musculoskeletal Science and Practice, 54, 102385
Patient experiences regarding medication for sciatica
First line treatments for many forms of lower back pain, including sciatica, are often medications. A study in the Journal Musculoskeletal Science and Practice has explored sciatica patients experiences on medication, noting issues around cost, lack of effectiveness, side effects, and fear of addiction. Such findings have steady implications on healthcare practice and the use (and sometime over use/prescription) of medication for pain.
Patient focused care in musculoskeletal practice
Patient-centered care in musculoskeletal practice and rehabilitation remains a key feature in best practice and quality of care for individuals with chronic musculoskeletal pain. However, an article from the journal of Musculoskeletal Science and Practice which covers content from the 2021 World Physiotherapy Congress (online), has noted that clinicians may experience difficulties with integrating patient-centered care into their everyday practice. The article covers aspects like patient connections, shared decision making, self-management support, and implementation.
Hutting, N., Caneiro, J. P., Ong’wen, O. M., Miciak, M., & Roberts, L. (2021). Patient-centered care in musculoskeletal practice: key elements to support clinicians to focus on the person. Musculoskeletal Science and Practice, 102434.
Upper limb neurodynamic tests for cervical radiculopathy
An article published in the journal of journal of Musculoskeletal Science and Practice discusses the use of Upper Limb Neurodynamic Tests (ULNT) in the diagnosis of neuropathic conditions. The research team utilised a diagnostic accuracy study design involving 109 individuals with suspected cervical radiculopathy. The findings noted that ULNTs when used singularly were not effective however when used in conjunction, they may yield higher clinical utility and may rule in or rule out cervical radiculopathy.
Grondin, F., Cook, C., Hall, T., Maillard, O., Perdrix, Y., & Freppel, S. (2021). Diagnostic accuracy of upper limb neurodynamic tests in the diagnosis of cervical radiculopathy. Musculoskeletal Science and Practice, 55, 102427.
The use of manual therapy for chronic neck pain
An invited commentary published with the JAMA Network Open discusses the use of manual therapy as non-pharmacological treatment option for chronic neck pain.
A case series on osteopathic interventions via telehealth in a paediatric population.
Over the course of the Covid-19 pandemic, certain aspects of healthcare delivery have been forcibly shifted from its rigid system to that of online telehealth. While for some disciplines, the shift was simpler, for other disciplines it was a challenge. As noted by a study by Kramer and team from the Pheonix Children’s Hospital in Arizona (USA), the delivery of manual therapies such as osteopathy via telehealth was a unique challenge as such therapies are typically provided physically, in-person, by a trained osteopath. However, the small case series observed that it was possible to see improvement in patient symptoms even via telehealth treatment. While it is important to note that the authors trialled the telehealth interventions with a considerably small number of patients and parents who were familiar with the techniques being used, the case series still reflects the capability of osteopathic care being applied in a safe and effective manner via telehealth.
DNA changes associated with exercise
A study published in Molecular Metabolism has discussed the changes in skeletal muscle gene expression following exercise training. It is well known that regular physical exercise improves overall health, but information surrounding the mechanisms for these improvements continues to grow. Health changes associated with physical activity are partially driven by adaptations in muscle tissue and of notable significance, the study concluded that skeletal muscle enhancers were significantly enriched following endurance exercise training. As stated by the authors, the study provides insight into the mechanisms mediating the positive effects of exercise on platelet biology as well as cardiovascular, cognitive, and renal function.
Williams, K., Carrasquilla, G. D., Ingerslev, L. R., Hochreuter, M. Y., Hansson, S., Pillon, N. J., & Barrès, R. (2021). Epigenetic rewiring of skeletal muscle enhancers after exercise training supports a role in whole-body function and human health. Molecular metabolism, 53, 101290.
Considerations of mandatory Covid jabs for high-risk workers
An article published in the Medical Journal of Australia covers medico-legal considerations relating to mandatory vaccinations of high-risk workers such as healthcare workers.
Kevat, D. A., Panaccio, D. C., Pang, S. C., Dean, J. M., Farmer, C. C., & Mahar, P. D. (2021). Medico-legal considerations of mandatory COVID-19 vaccination for high risk workers. The Medical journal of Australia, 215(1), 22–24.e1.
A look into soft-collar use in the rehabilitation of whiplash-associated disorders
Whiplash and whiplash associated disorders are a common occurrence following motor vehicle accidents. A review published in the journal of Musculoskeletal Science and Practice covers the potential use of soft collars for whiplash associated disorders. The four randomised control trials reviewed all favoured an active approach and/or act-as-usual approach to treatment over soft-collar treatment. However additional research investigating soft collar use in combination with active rehabilitation is still needed.
Christensen, S., Rasmussen, M. B., Jespersen, C. L., Sterling, M., & Skou, S. T. (2021). Soft-collar use in rehabilitation of whiplash-associated disorders - A systematic review and meta-analysis. Musculoskeletal science & practice, 55, 102426. Advance online publication.
A commentary on the osteopathic body-mind-spirit tenet
An article published in the International Journal of Osteopathic Medicine discusses the clinical relevance of the body-mind-spirit (BMS) tenet in contemporary osteopathic practice. The authors noted a focus on osteopathy’s potential for “evidence-informed person-centred” practice but highlighted the lack of definition and associated clinical practices of the body-mind-spirit tenet and in turn propose the development of an evidence-oriented framework that integrates core features of the BMS tenet.
Zegarra-Parodi, R., Esteves, J., Lunghi, C., Baroni, F., Draper-Rodi, J., Cerritelli, F. (2021). The legacy and implications of the body-mind-spirit osteopathic tenet: A discussion paper evaluating its clinical relevance in contemporary osteopathic care.
Patients’ interpretation of the consent process before manual therapy of the cervical spine
Ongoing informed consent is a considerably important topic in modern medical and health practice. Researchers from the United Kingdom have noted that patients undergoing manual therapy may perceive a power divide in addition to other influences which may affect their perception and experience of consent prior to treatment. The authors concluded that a need for additional reflection and training was needed on existing communication strategies and current consent practices.
Reed, M., Thomson, P. (2021). “Who am I to disagree?” A qualitative study of how patients interpret the consent process prior to manual therapy of the cervical spine. International Journal of Osteopathic Medicine, 40; 4-13.
The rise of percussive massage treatments
Handheld percussive massage devices are rapidly gaining popularity in both professional and non-professional athletic circles. A study by Konrad and team at the University of Graz, Mozartgasse, Austria has discussed the acute effects of using a percussive massage device on plantar flexor motion and performance. 16 male athletes took part in the study which found an increase in range of motion following use of the percussive massage device however, no change was noted in maximum voluntary contraction. It should be noted that little research is available on the use, safety, and efficacy of percussive massage devices. While presumably rare, a case study published in the Physical Therapy and Rehabilitation Journal noted a patient with rhabdomyolysis following ongoing use of a percussive massage device emphasising the need to further evaluate the safety and effectiveness of these devices.
Konrad, A., Glashüttner, C., Reiner, M. M., Bernsteiner, D., & Tilp, M. (2020). The Acute Effects of a Percussive Massage Treatment with a Hypervolt Device on Plantar Flexor Muscles' Range of Motion and Performance. Journal of sports science & medicine.
Muscle stretching and massage for the treatment of chronic neck pain.
As the prevalence of neck pan continues to increase worldwide, research in the area is ever increasing and aims to both prevent and/or support interventions and treatment options for the large number of people who suffer from the condition. A randomised single blind study from the Kırşehir Ahi Evran University in Turkey has investigated the effects of Sternocleidomastoid (SCM) muscle stretching and massage on pain, endurance, disability, range of motion, and kinesiophobia in individuals with chronic neck pain. The study utlilised 60 participnats, with a 50:50 split of between the SCM and control groups. Authors noted improvements in pain, disability, range of motion and endurance, suggesting that stretching and massage applied to the SCM-muscle, together with conventional physio, may reduce pain and disability, while increasing range of motion and endurance in those with chronic neck pain.
Büyükturan, B., Şaş, S., Kararti, C., & Büyükturan, Ö. (2021). The Effects of Combined Sternocleidomastoid Muscle Stretching and Massage on Pain, Disability, Endurance, Kinesiophobia, and Range of Motion in Individuals with Chronic Neck Pain: A randomized, single-blind study. Musculoskeletal Science and Practice, 102417.
Decrease in sarcomere numbers in patients following stroke
Researchers at Northwestern University have recently found that stroke patients had a significant loss in sarcomeres along the length of the muscle, which hasn’t previously been demonstrated in humans. The team used MRI, ultrasound, and microendoscopy to measure functional parameters in stroke patients compared to healthy controls.
The study has implications for patients who experience abnormal amounts of muscle stiffness and tight joints following impairment – suggesting that changes in muscle structure may be part of the problem. Of further significance is that the study establishes the ability to investigate muscle adaptations in humans without being limited to tissue samples from a biopsy or measurements during surgery.
A long-term look at graded exercise self-help to improve symptoms of chronic fatigue syndrome
Chronic fatigue syndrome (CFS) is a disorder characterised by persistent fatigue that causes dysfunction to daily life. There has been a growing body of evidence suggesting that patients with CFS may benefit from various forms of exercise therapy.
The GETSET trial – a randomised controlled trial of UK patients with CFS – aimed to assess graded exercise self-help (GES) alongside long-term health and economic outcomes. The study found that short-term fatigue reduction (at 12 weeks) was maintained at long-term follow-up (at 15 months) for participants assigned to the graded exercise program. However, no additional improvement was noted at the long-term follow-up. While additional research is still required in the area, trials such GETSET are an important initiative to determine long-term outcomes for patients who suffer from CFS.
Clark, L. V., McCrone, P., Pesola, F., Vergara-Williamson, M., & White, P. D. (2021). Guided graded exercise self-help for chronic fatigue syndrome: long term follow up and cost-effectiveness following the GETSET trial. Journal of Psychosomatic Research, 146, 110484.
Explaining central sensitisation to patients reporting chronic unexplained musculoskeletal pain
Reconceptualising pain remains an important aspect when commencing rehabilitation services for patients with chronic unexplained pain. This is commonly achieved using patient education.
Pain physiology education has been shown to effectively change pain perceptions and improve health status in patients with musculoskeletal pain disorders. Patient education about central sensitisation and its role in chronic pain may be a particularly useful tool to help patients understand their pain. Central sensitisation (characterised by generalised or widespread pain hypersensitivity) provides an evidence-based explanation for some cases of chronic unexplained musculoskeletal pain.
Nijs, J., Paul van Wilgen, C., Van Oosterwijck, J., van Ittersum, M., & Meeus, M. (2011). How to explain central sensitization to patients with 'unexplained' chronic musculoskeletal pain: practice guidelines. Manual therapy, 16(5), 413–418.
Nijs, Jo & George, Steven & Clauw, Dan & Fernández-de-Las-Peñas, César & Kosek, Eva & Ickmans, Kelly & Fernández-Carnero, Josué & Polli, Andrea & Kapreli, Eleni & Huysmans, Eva & Cuesta-Vargas, Antonio & Mani, Ramakrishnan & Lundberg, Mari & Leysen, Laurence & Rice, David & Sterling, Michele & Curatolo, Michele. (2021). Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine. The Lancet Rheumatology. 3.10.1016/S2665-9913(21)00032-1.
A review of the validity of lumbo–pelvic landmark palpation
Osteopaths, alongside other manual therapists, often use palpation as part of a lower back or pelvic assessment. A recent review published in the International Journal of Osteopathic Medicine noted that, lumbo–pelvic landmark palpation, while common, has not achieved clearly established validity as a clinical tool. The authors further suggest a shift away from the over-reliance on landmark palpation in order to align manual therapy with practice guidelines.
Alexander, N., Rastelli, A., Webb, T.R., & Rajendran, D. (2020). The validity of lumbo-pelvic landmark palpation by manual practitioners: a systematic review. International Journal of Osteopathic Medicine. 39. 10.1016/j.ijosm.2020.10.008.
Use of integrative and complementary healthcare services by people with spinal cord injury.
A recent descriptive study published in the Archives of Physical Medicine and Rehabilitation has depicted the use of complementary and integrative health services by people with spinal cord injury. The study suggests that patients may use at least one if not more complementary and/or integrative approaches. The implications for rehabilitation clinicians and the importance of open dialogue with patients is also discussed.
Coker, J., Berliner, J., Botticello, A., Bryce, T. N., Charlifue, S., Chen, D., Estrada, D., Monden, K. R., Taylor, H., Zafonte, R., & Zanca, J. M. (2021). Utilization of complementary and integrative healthcare by people with spinal cord injury in the Spinal Cord Injury Model Systems: A descriptive study. Archives of physical medicine and rehabilitation, S0003-9993(21)00400-7. Advance online publication.
The potential for osteopathy to regulate brain–heart modulation in chronic pain
A recent study published in Nature – Scientific Reports suggests that osteopathic treatment may be able to modulate brain–heart interactions. Cerritelli et al used cerebral blood flow (CBF) and heart rate variability (HRV) to demonstrate that patients receiving osteopathic treatment showed a decrease in CBF in some regions of the brain associated with pain. This change was also associated with changes in HRV parameters and a reduction in reported pain by the treatment group. The study begins to increase the knowledge base surrounding the neurobiological and physiological changes associated with osteopathic interventions for chronic pain.
Cerritelli, F., Chiacchiaretta, P., Gambi, F., Saggini, R., Perrucci, M. G., & Ferretti, A. (2021). Osteopathy modulates brain-heart interaction in chronic pain patients: an ASL study. Scientific reports, 11(1), 4556.